4 Steps to Make Time for Time Out

National Time Out Day is June 8, but you and your team should take a closer look at your Time Out today to make sure you are giving adequate time to this final safety check before every procedure, stresses AORN Executive Director/CEO Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN.

“A significant uptick in wrong site surgeries over the past three years indicates teams are not giving enough time for a consistent and fully engaged Time Out,” Groah stresses. She fears the emphasis on ‘efficiencies’ might be a contributing factor for even more wrong site surgeries this year as many teams face packed schedules to get patients in for surgeries that had to be delayed during the pandemic.

With an influx of new periop team members, including travel nurses who may not feel comfortable speaking up, Groah says “teams need to make sure they are making time to fully engage the entire team in the Time Out.”

AORN and The Joint Commission have launched a national campaign, Make Time for Time Out, to encourage every team to check that a Time Out is being conducted in an optimum way to catch dangerous and even deadly Never Events such as wrong site surgery.

Wrong Site Surgery by The Numbers

Last year, wrong site, wrong side, or wrong procedure surgeries remained among the top reported surgical sentinel events reported to The Joint Commission. Looking back over the past three years of sentinel event data, 52 wrong site surgeries were reported in 2019, 68 were reported in 2020, and 85 were reported in 2021. Groah describes this steady uptick of wrong site surgeries as very concerning, especially considering only an estimated 2% of sentinel events are reported to The Joint Commission.

That’s why this year’s National Time Out Day campaign reiterates the need to Make Time for Time Out, to provide time to catch common safety risks that we know lead to wrong site surgery, such as rushing and distractions, errors in scheduling, and a lack of team communication. Groah worries that complacency about wrong site surgery is another contributing factor. “If a team has never experienced a wrong site surgery, they may mistakenly believe it can’t happen on their watch, however, the data show otherwise.”

Research also describes the distress and even career-altering impact a wrong site surgery can have on perioperative team members who did not catch a wrong site surgery before it occurred.

Make Time for Time Out

While the surgical site marking and safety checks to review the procedure often happen before the patient enters the operating room, the Time Out is the last chance for every member of the team to review patient and procedure details together and speak up with any safety concerns.

“The average two-minutes it takes for a fully engaged Time Out is time well spent for patient safety,” Groah stresses, noting “there is simply no excuse not to make time for this critical safety moment for every patient.”

Once you’ve committed as a team to Make Time for Time Out, Groah suggests these four steps to assess and improve your Time Out together.

Step 1: Observe Time Out Practices

Audit Time Outs to see how engaged team members are in every step of the Time Out as part of the Surgical Safety Checklist established at your facility. Here are some examples of questions to ask and look for during a Time Out audit:

• Is the person designated to lead the Time Out always leading the Time Out?
• Are all members of the team speaking engaged during the complete Time Out?
• Are all other activities in the OR halted for the complete duration of the Time Out?

Step 2: Review Time Out Observations as a Team

Findings from a series of Time Out audits should be reviewed by all members of the team in a non-punitive way so improvements can be discussed and agreed upon. From this discussion, the team should develop proposed Time Out improvements.

Step 3: Test Time Out Improvements

Proposed Time Out changes should be tested prior to implementation to assess effectiveness and “fit” for every team member. For example, if a team decides that the mayo stand will not be moved to the OR table until the fully engaged Time Out is completed, this new process should be tested to ensure feasibility and timing.

Step 4: Enlist a Time Out Champion on Every Team

Whether it’s the surgeon, the RN Circulator, or a different team member leading the Time Out, a designated person should champion every Time Out. This person should feel equally confident to address safety concerns and encourage others on the team to also address any concerns they may observe.